The American Society of Plastic Surgeons (ASPS) has issued new guidance urging its members to delay gender-affirming breast, genital and facial surgeries for young people until they are at least 19 years old, citing insufficient evidence on the long-term balance of risks and benefits.
ASPS, which represents more than 11,000 physicians, released a position statement in early February recommending that such surgical procedures not be performed on children or adolescents under the age of 19 because the current evidence base is ‘low quality’ and does not clearly demonstrate a favourable risk-benefit profile.
The guidance applies to chest surgery, genital surgeries and facial procedures conducted as part of gender transition. It is not a formal clinical practice guideline but rather professional guidance intended to inform members about ongoing uncertainty in the scientific literature.
ASPS leaders said that reviews of existing research – including recent systematic analyses and government reports – have not resolved lasting uncertainties about benefits and potential long-term harms of these interventions in developmentally vulnerable patients. The group emphasised that decisions should remain individualised and made by clinicians in consultation with patients.
The statement also pushed back against punitive government actions targeting providers of gender-affirming care, saying regulation of medical care is better achieved through professional self-regulation rather than criminal law or legislative bans.
Divergent reactions in a politically charged environment
Health officials from the United States Department of Health and Human Services under the current administration quickly welcomed the ASPS recommendation, while other medical groups such as the American Medical Association have broadly agreed that surgeries for minors are typically deferred to adulthood but continue to support case-by-case decisions for other aspects of gender-affirming care.
The American Academy of Pediatrics (AAP) continues to support gender-affirming care for minors, maintaining that it is evidence-based and medically necessary. The AAP advocates for a case-by-case approach, resisting government interference in these medical decisions.
The issue remains politically sensitive in parts of the United States, with state-level legislation and federal policy positions varying. Critics of the ASPS position argue that delaying access may harm transgender and nonbinary adolescents experiencing significant gender dysphoria, while supporters welcome what they see as a more cautious, evidence-oriented approach.
Surgeries for gender transition at any age remain rare relative to other plastic surgery procedures, and they typically follow comprehensive psychological and medical assessment within specialised multidisciplinary settings. For many transgender and gender-diverse people, however, these interventions can form an important part of comprehensive care when undertaken in carefully assessed clinical settings.
